title: Radiation pneumonitis in patients with lung and mediastinal tumours: a retrospective study of risk factors focused on pulmonary emphysema.
abstract: OBJECTIVE
  To evaluate the impact of pulmonary emphysema (PE) on the incidence and severity of radiation pneumonitis (RP) in patients with lung and mediastinal tumours.
  
  
  METHODS
  92 patients were enrolled. Involved-field radiation therapy (non-small cell carcinoma or mediastinal tumours in 69 patients; median 70 Gy) and accelerated hyperfractionation (limited disease small cell carcinoma in 23 patients; median 45 Gy) were performed. Common Terminology Criteria for Adverse Events v.3.0 was used to evaluate RP and the relationship with the percentage of pulmonary volume irradiated to >20 Gy (V20) and PE. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and was classified into Grades 0-4 according to the extent of the LAAs.
  
  
  RESULTS
  The median follow-up time was 16 months. The 6-month cumulative incidence of RP at Grade 3 or greater was 7.7% and 34.1% in patients with a V20 of <25% and ≥25%, respectively (p=0.017). In patients with PE Grades 0, 1, 2 and 3 or greater, the incidence of RP was 16.5%, 9.1%, 8.6% and 54.0%, respectively. As the PE Grade increased, the incidence of RP also increased significantly.
  
  
  CONCLUSIONS
  The incidence and severity of RP are significantly higher in patients with a high V20 value as well as in those with severe PE.
authors.affiliation: Department of Radiology, Kagawa University, Faculty of Medicine, Kagawa, Japan. tkkimura@hiroshima-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Togami
authors.forename: H
authors.initials: H
authors.lastname: Takashima
authors.forename: Y
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: M
authors.initials: M
authors.lastname: Ohkawa
authors.forename: Y
authors.initials: Y
authors.lastname: Nagata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000532:radiotherapy*; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017564:Radiation Pneumonitis / Q000145:classification / Q000453:epidemiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed